015700263-5-8-2023-52-CC-RHAR-CRMPAN-20230508110901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700263
Report Date: 05/08/2023
Date Signed: 05/08/2023 11:09:11 AM

Document Has Been Signed on 05/08/2023 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	PEREDA LOPEZ, ZAHAIRA		FACILITY NUMBER:	015700263
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 9	CENSUS: 3	DATE:	05/08/2023
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Zahaira Lopez Pereda		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 8, 2023 at approximately 9:00am Licensing Program Analyst (LPA) Haderer arrived for an announced case management visit for a capacity change inspection. Present in the home today was licensee Zahaira Lopez Pereda, her fingerprint cleared and TB tested assistant and adult daughter, and 3 children in care (1 three-year old; 2 four-year old). The facility is in ratio today. Hours of operation are 7:30 to 6:00pm. All requested documents were received for the increase of capacity application. The fire clearance for a capacity of 14 was approved by the Fremont Fire Department on 05/03/2023 (received by Licensing on 5/04/2023). The Licensee is reminded to abide by the conditions of the fire clearance (day care not permitted in the garage). Pull down fire alarm has been installed in the daycare room near the exit door to the backyard patio area. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. A copy of the approved children ratios was printed and given to licensee.If licensee has the maximum of 14 children in care, a signed LIC9150 will be required from all parents of children in care. Requirements for assistants: Fingerprint clearance LIC 501 Personnel Record Application (or job app) LIC 9052 Employee Rights (signed by employee) Immunizations for: MMR, tdap, influenza (influenza flu shot may be declined with a signed and dated note stating the election not to have a flu shot) Clear TB test with a negative result or x-ray clearance CPR/1st Aide if ever left alone with children Mandated Reporter (current within 2-years, not expired) LIC 9108 Statement Acknowledging requirement to report child abuse

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREDA LOPEZ, ZAHAIRA	FACILITY NUMBER: 015700263
	VISIT DATE: 05/08/2023

NARRATIVE

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Personnel file check for new helper Olga Aguilar and she still needs proof of measles immunization or a blood test showing immunity and also a flu shot or a signed note declining the shot.

The facility is a single story 3-bedroom, 2 bath home with an attached 2-car garage (including an inground swimming pool in the back yard with a 5-foot fence surrounding the pool – see below). The back yard has a gazebo and a small pumphouse for the pool. There is a living room with a covered fire place, family room with a faux fireplace feature built into the wall, dining room, large kitchen (half has the stove and sink area, the other half was formerly the kitchen and has been covered into a bar area), three bedrooms (1 master with an attached sunroom), attached 2-car garage an enclosed (fenced) side and backyard area.

POOL: The backyard has an inground pool with a five-foot fence completely surrounding the perimeter. The pool fence is constructed with a mesh material to allow for visual view into the pool. There is a gate that swings away from the pool and has a self-closing and self-latching gate with the latch at the top.

On-limit-areas include: Entryway of the home, family room, bar area of the kitchen, the NW side bedroom for napping and main house bathroom on left side of the bedroom for napping, and main back yard area, the gazebo and the outside perimeter of the pool fence surrounding the pool in the backyard. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: The living room, dining room; hallway leading to the SW and NW bedrooms, the bedroom on the SW side and the master bedroom and bathroom on the NW side; the sun room, the attached 2-car garage, front yard and fenced side yards and inground pool in the backyard and pool pumphouse. The off-limit areas will be inaccessible by closed and/or locked doors, child gates and/or by child supervision.

The home is owned by the licensee. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the on-limits bedroom away from the other children in care.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREDA LOPEZ, ZAHAIRA	FACILITY NUMBER: 015700263
	VISIT DATE: 05/08/2023

NARRATIVE

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There is a faux fireplace on the wall of the family room (day care area) with a glass door to prevent child access. This feature will not be used when children are present. Children have cubbies for personal item storage. A copy of the deed is available showing the licensee owns the property. Per licensee, there are no firearms in the home.

Licensee has ample age-appropriate toys and learning materials inside and outside. In the backyard there is a large children’s play structure in the backyard for climbing with a slide and swings and is securely attached to the ground. There is a gazebo for seating with covered gas and charcoal barbeques, and a covered pizza oven and a non-functioning fire pit. If the fire pit is repaired, it will not be used while children are in care. There is a covered sandbox containing clean sand and toys and other age-appropriate toys for children to play with.

The home has a fully charged 2A10BC fire extinguisher mounted on the kitchen wall and a second extinguisher under the kitchen sink. There are working smoke detectors throughout the home; a carbon monoxide detector (tested and functioning), and a working telephone. The licensee’s Health and Safety training was completed 6/13/2021 (including the nutrition and Lead Poisoning Prevention requirements), CPR and First Aid certificate is current and expires 6/5/2023. Mandated Reporter has been completed and expires 7/28/2023. The licensee is in compliance with all immunization laws which pertains to day care providers.

LPA reminded licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

LPA did not observe any bodies of water (other than the appropriately fenced and enclosed inground pool), hazardous materials, or toxins accessible to children on the premises during the inspection.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PEREDA LOPEZ, ZAHAIRA	FACILITY NUMBER: 015700263
	VISIT DATE: 05/08/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

There were no deficiencies issued today.

This home is recommended for an increase of capacity as of 05-08-2023. The report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Zahaira Lopez Pereda.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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